Cancer of Vulva

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Cancer of Vulva

Incidence: it accounts for 4% of genital tract malignancies.

Aetiology: No specific etiological factor has been found in vulvar cancers, though many cases are associated / preceded by vulvar dystrophies and VIN. Some association has been found with HPV infection, specially in young women.

Symptoms& signs

1. Itching at vulva (labia majora, minora, fourchette, periurethral region, cliral or peri-clitoral region)
2. change in pigmentation of skin and mucosa in vulva region
3. mass in vulvar region
4. rarely bleeding or infected fungating large tumors in vulvar region in late neglected cases.

Stages of Vulvar Cancer

Stage 0 (Carcinoma in Situ): Abnormal cells confined to skin

Stage I: cancer localized to vulva only or in the vulva and perineum, but size < 2cms

Stage II: cancer in vulva and perineum of size >2cms

Stage III: cancer is of any size, but spread is present to unilateral groin nodes or to lower third vagina / urethra or anus

Stage IV: spread to bilateral groin nodes /upper part of urethra/bladder/rectum/pelvic bone/ distant metastasis

Treatment

Role of Surgery in management of vulvar cancers

• There had been a paradigm shift in vulvar cancer management with individualization, multidisciplinary treatment with stress on vulvar conservation surgeries in localized vulvar cancers.
• Primarily patient is treated with conservative or radical surgeries
• Groin node dissection is done along with vulvar surgery, followed by adjuvant radiotherapy if indicated by final histopathology report.

Role of radiotherapy in management of vulvar cancers

• After surgery to prevent local recurrence , if margins are close
• As primary treatment, in small primary lesions of clitoral or para-clitoral in young women
• In cases of microscopic or macroscopic groin node metastasis
• If lesion is too close to anal sphincter or involving the upper urethra or vagina

Role of chemotherapy in management of vulvar cancers: in stage IV with distant metastasis cases

Prognosis: with appropriate management 5 year survival rate in operable cases is generally good in range of 70%. The stage wise prognosis is 98%,85%, 74% and 31% in stage I,II, III and IV respectively. Positive groin lymph nodes and their number worsen the prognosis.

VIN (premalignant stage of vulvar cancers): Colposcopy has a role in detecting it in premalignant stages (Vulvar intraepithelial Neoplasia) before it gets transformed into fully malignant form. VIN can be treated with very simple procedures like laser excision/ knife excision. Some other predisposing conditions need regular biopsies and require prolonged local steroid ointment and regular follow up.